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European Journal of Gynaecological Oncology  2021, Vol. 42 Issue (1): 183-188    DOI: 10.31083/j.ejgo.2021.01.2278
Special Issue: Topic Collection "Minimally Invasive Surgery in Gynecological Oncology"
Case Report Previous articles | Next articles
A modified technique of laparoscopic radical trachelectomy combined with extracorporeal cervical amputation through a mini-laparotomy
Zen Watanabe1, Hideki Tokunaga1, *(), Masumi Ishibashi1, Shogo Shigeta1, Keita Tsuji1, Tomoyuki Nagai1, Masahito Tachibana1, Muneaki Shimada1, Nobuo Yaegashi1
1Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574 Miyagi, Japan
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Abstract  
Radical trachelectomy is an optional fertility-sparing treatment for early-stage cervical cancer, and recently, the minimally invasive approach (MIA) has become a major trend in radical trachelectomy. MIA radical trachelectomy requires a more careful surgical technique to avoid tumor spillage and exposure of the cancerous tissue under carbon dioxide pneumoperitoneum to reduce the risk of recurrence. We present a case of a 33-year-old nulliparous woman with stage IB1 cervical cancer who underwent MIA radical trachelectomy through a combination of laparoscopic surgery and mini-laparotomy, mainly to prevent postoperative complications and tumor spread during cervical amputation. A Papanicolaou test suggested the diagnosis of squamous cell carcinoma of the cervix without any symptoms such as atypical bleeding. The subsequent biopsy revealed squamous cell carcinoma with stromal invasion of the cervix. Cervical amputation was performed extracorporeally through a small incision in the lower abdomen. There were no perioperative complications. The patient was discharged on postoperative day 13. The final pathological evaluation revealed residual microinvasive cancer of the endocervical canal with clear margins, no lymphovascular space involvement, and 27 negative lymphatic nodes. The joint of the neo-cervix and vagina had healed completely without erosion or stenosis of the cervical canal, and no problems occurred during sexual intercourse. No cancer recurrence or menstrual disorders have been reported in the short postoperative period of 6 months. The surgical technique of laparoscopic radical trachelectomy combined with extracorporeal cervical amputation may be an acceptable alternative to reduce the risk of recurrence by preventing intraperitoneal tumor spillage.
Key words:  Cervical cancer      Radical trachelectomy      Minimally invasive approach      Fertility preservation      Mini-laparotomy      Cervical amputation      Extracorporeal     
Submitted:  20 October 2020      Revised:  08 December 2020      Accepted:  16 December 2020      Published:  15 February 2021     
*Corresponding Author(s):  Hideki Tokunaga     E-mail:  hideki.tokunaga.a1@tohoku.ac.jp

Cite this article: 

Zen Watanabe, Hideki Tokunaga, Masumi Ishibashi, Shogo Shigeta, Keita Tsuji, Tomoyuki Nagai, Masahito Tachibana, Muneaki Shimada, Nobuo Yaegashi. A modified technique of laparoscopic radical trachelectomy combined with extracorporeal cervical amputation through a mini-laparotomy. European Journal of Gynaecological Oncology, 2021, 42(1): 183-188.

URL: 

https://ejgo.imrpress.com/EN/10.31083/j.ejgo.2021.01.2278     OR     https://ejgo.imrpress.com/EN/Y2021/V42/I1/183

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